Quality improvement project to improve smoking cessation among an oncology cohort at a large US multistate cancer center.

Authors

Thulasee Jose

Thulasee Jose

Mayo Clinic, Rochester, MN

Thulasee Jose, Joshua Ohde, David O. Warner

Organizations

Mayo Clinic, Rochester, MN

Research Funding

Other
This CTSA Grant Number TL1 TR002380 from the National Center for Advancing Translational Science (NCATS) Institutional Funding

Background: Assessing tobacco use and providing cessation support is recommended by the American Society for Clinical Oncology (ASCO). As part of the National Cancer Institute Cancer Center Cessation Initiative, we established an electronic health record based "opt-out" approach to refer patients to tobacco treatment specialists. However, the role of oncologists in contributing to the “opt-out” approach to patients has not been explored. We tested the hypothesis that a multi-component educational program for oncologists would increase the proportion of patients who completed tobacco treatment appointments. Methods: As a quality improvement initiative, oncology providers at the Rochester Mayo Clinic Cancer Center were educated using a multimodal academic detailing approach with group and individual educational sessions. Its effectiveness was tested using a modified step-wedge implementation design. The primary outcomes were patient behaviors that could plausibly be changed by conversations with their provider: the rate at which cancer patients identified as current tobacco users scheduled an appointment in the Nicotine Dependence Center, and the rate at which patients scheduled for a NDC appointment completed their appointment. Comparisons were made before, during, and after the education period (from July through Dec 2019) and with a separate group of providers who did not complete education (results examined over a similar time period). Results: Education intervention did not improve outcomes among providers who received education; indeed, the rate of appointment scheduling decreased, although this may reflect other concurrent changes in the tobacco treatment referral process (Table 1). Outcomes were similar between oncology providers who did and did not receive multicomponent education intervention. Conclusions: Smoking cessation efforts can be successfully integrated into routine cancer care. The implementation of the “opt-out” referral system resulted in approximately 1 in 5 patients being seen for tobacco use, but a multicomponent education intervention designed to equip oncologists to encourage patients to complete appointments was not effective. Novel approaches are needed to increase the uptake of tobacco treatment among patients.

Tobacco treatment referrals and appointment outcomes according to provider education status.

Educated Providers (n = *)Non-educated Providers (n = *)

Characteristic
Pre-educationDuring educationPost-Education
p-value*
July-SeptemberOctober-January
p-value*
Identified tobacco users285493604564
Among identified tobacco users
Any referral placed235 (82%)39 (80%)287 (80%)0.4236 (80%)48 (75%)0.64
Among referrals placed
Any appointment scheduled153 (65%)18 (46%)132 (46%)< 0.00124 (67%)23 (48%)0.08
Among appointments scheduled
Any appointment completed30 (20%)7 (39%)27 (20%)0.886 (25%)6 (26%)1

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Abstract Details

Meeting

2023 ASCO Quality Care Symposium

Session Type

Poster Session

Session Title

Poster Session A

Track

Quality, Safety, and Implementation Science,Cost, Value, and Policy,Patient Experience,Survivorship

Sub Track

Quality Improvement Research and Implementation Science

Citation

JCO Oncol Pract 19, 2023 (suppl 11; abstr 435)

DOI

10.1200/OP.2023.19.11_suppl.435

Abstract #

435

Poster Bd #

J17

Abstract Disclosures

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